What is the most commonly injured organ in penetrating abdominal trauma?

Most Commonly Injured Organ in Penetrating Abdominal Trauma

The small intestine is the most commonly injured organ in penetrating abdominal trauma, with the colon being the second most frequently affected. 1, 2

Epidemiology of Penetrating Abdominal Trauma

• Penetrating trauma is the most common cause of duodenal injury in adults, accounting for 53.6-90% of cases 3
• In penetrating abdominal trauma, hollow viscus injuries occur in approximately 17% of cases, compared to only 1% in blunt trauma 3
• The small intestine and colon are the most prevalent abdominal organs damaged in penetrating warfare injuries 1

Organ-Specific Injury Patterns in Penetrating Trauma

Small Intestine

• Most frequently injured organ in penetrating abdominal trauma 1, 2
• Multiple perforations of the jejunum represent the most common pattern of small bowel injury 4
• Small bowel injuries from penetrating trauma tend to be higher grade (grade III and IV) compared to blunt mechanisms 4
• These injuries are typically managed with resection and stapled anastomosis 4

Colon

• Second most commonly injured organ in penetrating abdominal trauma 1, 5
• The transverse colon is most frequently affected, followed by ascending, descending, and sigmoid segments 5
• Penetrating wounds account for approximately two-thirds of large intestine injuries 5
• Management typically involves simple suture repair for right and transverse colon injuries, while left colon injuries may require proximal colostomy 5

Kidney

• The kidney is the most commonly injured genitourinary organ but ranks lower than hollow viscus organs in overall penetrating abdominal trauma 3
• Penetrating trauma accounts for only 1.4-3.3% of kidney injuries overall 3
• Renal vascular injuries are more frequent in penetrating trauma compared to blunt mechanisms 3
• Isolated penetrating kidney injuries are rare 3

Ureter

• Ureteral injuries are rare, accounting for only 1% of urologic injuries 3
• The majority of ureteral injuries outside the operating room result from penetrating trauma 3
• The posterior position of the ureter makes it less vulnerable to direct injury compared to more anterior vascular structures 6

Diagnostic Considerations

• All hemodynamically stable patients with penetrating abdominal trauma should undergo imaging regardless of the degree of hematuria 3
• CT has a sensitivity of 88% and specificity of 72% for detecting bowel injury in penetrating trauma 3
• CT sensitivity is higher for gunshot wounds (88%) than for stab wounds (80%) 3
• Free fluid is the most common CT finding of bowel injury, followed by mesenteric stranding, bowel wall thickening, and contrast extravasation 3

Management Principles

• Non-operative management (NOM) can be performed at specialized centers for hemodynamically stable and cooperative patients with penetrating abdominal trauma 3
• NOM is more suitable for stab wounds compared to gunshot wounds 3
• When CT does not identify hard signs of bowel injury, local wound exploration or screening laparoscopy should be used to investigate for peritoneal violation 3
• NOM requires at least 48 hours of serial clinical examinations by consistent specialists, vital sign monitoring, and serial inflammatory marker testing 3
• Most small bowel injuries are managed with resection and stapled anastomosis, even in the presence of shock 4

Complications and Outcomes

• The overall mortality from gastrointestinal surgery in penetrating trauma is approximately 3.6% 1
• The most common reason for death is complications related to gastrointestinal operations, such as anastomotic leak 1
• Mortality rates are higher when the first operation is performed at frontline hospitals (7.5%) compared to second-line hospitals (3.2%) 1
• Complications occur in approximately 50% of patients with colon injuries, most frequently wound infection and intra-abdominal abscess 5